Maternal and Child Health Nursing Practice Quiz #9 (50 Questions)

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Maternal and Child Health Nursing Practice Quiz #9 (50 Questions)

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Question 1

Postpartum Period: The fundus of the uterus is expected to go down normally postpartally about __ cm per day.

A

1.0 cm

B

2.0 cm

C

2.5 cm

D

3.0 cm

Question 1 Explanation:

The uterus will begin involution right after delivery. It is expected to regress/go down by 1 cm. per day and becomes no longer palpable about 1 week after delivery.

Question 2

The lochia on the first few days after delivery is characterized as

A

Pinkish with some blood clots

B

Whitish with some mucus

C

Reddish with some mucus

D

Serous with some brown tinged mucus

Question 2 Explanation:

Right after delivery, the vaginal discharge called lochia will be reddish because there is some blood, endometrial tissue and mucus. Since it is not pure blood it is non-clotting.

Question 3

Lochia normally disappears after how many days postpartum?

A

5 days

B

7-10 days

C

18-21 days

D

28-30 days

Question 3 Explanation:

Normally, lochia disappears after 10 days postpartum. What’s important to remember is that the color of lochia gets to be lighter (from reddish to whitish) and scantier everyday.

Question 4

After an Rh(-) mother has delivered her Rh (+) baby, the mother is given RhoGam. This is done in order to:

A

Prevent the recurrence of Rh(+) baby in future pregnancies

B

Prevent the mother from producing antibodies against the Rh(+) antigen that she may have gotten when she delivered to her Rh(+) baby

C

Ensure that future pregnancies will not lead to maternal illness

D

To prevent the newborn from having problems of incompatibility when it breastfeeds

Question 4 Explanation:

In Rh incompatibility, an Rh(-) mother will produce antibodies against the fetal Rh (+) antigen which she may have gotten because of the mixing of maternal and fetal blood during labor and delivery. Giving her RhoGam right after birth will prevent her immune system from being permanently sensitized to Rh antigen.

Question 5

To enhance milk production, a lactating mother must do the following interventions EXCEPT:

A

Increase fluid intake including milk

B

Eat foods that increases lactation which are called galactagogues

C

Exercise adequately like aerobics

D

Have adequate nutrition and rest

Question 5 Explanation:

All the above nursing measures are needed to ensure that the mother is in a healthy state. However, aerobics does not necessarily enhance lactation.

Question 6

The nursing intervention to relieve pain in breast engorgement while the mother continues to breastfeed is

A

Apply cold compress on the engorged breast

B

Apply warm compress on the engorged breast

C

Massage the breast

D

Apply analgesic ointment

Question 6 Explanation:

Warm compress is applied if the purpose is to relieve pain but ensure lactation to continue. If the purpose is to relieve pain as well as suppress lactation, the compress applied is cold.

Question 7

A woman who delivered normally per vagina is expected to void within ___ hours after delivery.

A

3 hours

B

4 hours

C

6-8 hours

D

12-24 hours

Question 7 Explanation:

A woman who has had normal delivery is expected to void within 6-8 hrs. If she is unable to do so after 8 hours, the nurse should stimulate the woman to void. If nursing interventions to stimulate spontaneous voiding don’t work, the nurse may decide to catheterize the woman.

Question 8

To ensure adequate lactation the nurse should teach the mother to:

A

Breast feed the baby on self-demand day and night

B

Feed primarily during the day and allow the baby to sleep through the night

C

Feed the baby every 3-4 hours following a strict schedule

D

Breastfeed when the breast are engorged to ensure adequate supply

Question 8 Explanation:

Feeding on self-demand means the mother feeds the baby according to baby’s need. Therefore, this means there will be regular emptying of the breasts, which is essential to maintain adequate lactation.

Question 9

An appropriate nursing intervention when caring for a postpartum mother with thrombophlebitis is:

A

Encourage the mother to ambulate to relieve the pain in the leg

B

Instruct the mother to apply elastic bondage from the foot going towards the knee to improve venous return flow

C

Apply warm compress on the affected leg to relieve the pain

D

Elevate the affected leg and keep the patient on bedrest

Question 9 Explanation:

If the mother already has thrombophlebitis, the nursing intervention is bedrest to prevent the possible dislodging of the thrombus and keeping the affected leg elevated to help reduce the inflammation.

Question 10

The nurse should anticipate that hemorrhage related to uterine atony may occur postpartally if this condition was present during the delivery:

A

Excessive analgesia was given to the mother

B

Placental delivery occurred within thirty minutes after the baby was born

C

An episiotomy had to be done to facilitate delivery of the head

D

The labor and delivery lasted for 12 hours

Question 10 Explanation:

Excessive analgesia can lead to uterine relaxation thus lead to hemorrhage postpartally. Both B and D are normal and C is at the vaginal introitus thus will not affect the uterus.

Question 11

According to Rubin’s theory of maternal role adaptation, the mother will go through 3 stages during the postpartum period. These stages are:

A

Going through, adjustment period, adaptation period

B

Taking-in, taking-hold and letting-go

C

Attachment phase, adjustment phase, adaptation phase

D

Taking-hold, letting-go, attachment phase

Question 11 Explanation:

Rubin’s theory states that the 3 stages that a mother goes through for maternal adaptation are: taking-in, taking-hold and letting-go. In the taking-in stage, the mother is more passive and dependent on others for care. In taking-hold, the mother begins to assume a more active role in the care of the child and in letting-go, the mother has become adapted to her maternal role.

Question 12

The neonate of a mother with diabetes mellitus is prone to developing hypoglycemia because:

A

The pancreas is immature and unable to secrete the needed insulin

B

There is rapid diminution of glucose level in the baby’s circulating blood and his pancreas is normally secreting insulin

C

The baby is reacting to the insulin given to the mother

D

His kidneys are immature leading to a high tolerance for glucose

Question 12 Explanation:

If the mother is diabetic, the fetus while in utero has a high supply of glucose. When the baby is born and is now separate from the mother, it no longer receives a high dose of glucose from the mother. In the first few hours after delivery, the neonate usually does not feed yet thus this can lead to hypoglycemia.

Question 13

Which of the following is an abnormal vital sign in postpartum?

A

Pulse rate between 50-60/min

B

BP diastolic increase from 80 to 95 mmHg

C

BP systolic between 100-120 mmHg

D

Respiratory rate of 16-20/min

Question 13 Explanation:

All the vital signs given in the choices are within normal range except an increase of 15mm Hg in the diastolic which is a possible sign of hypertension in pregnancy.

Question 14

The uterine fundus right after delivery of placenta is palpable at

A

Level of xiphoid process

B

Level of umbilicus

C

Level of symphysis pubis

D

Midway between umbilicus and symphysis pubis

Question 14 Explanation:

Immediately after the delivery of the placenta, the fundus of the uterus is expected to be at the level of the umbilicus because the contents of the pregnancy have already been expelled. The fundus is expected to recede by 1 fingerbreadths (1cm) everyday until it becomes no longer palpable above the symphysis pubis.

Question 15

A nurse is monitoring the amount of lochia drainage in a client who is 2 hours postpartum and notes that the client has a saturated a perineal pad in 1 hour. The nurse reports the amount of lochial flow as:

In a woman who is not breastfeeding, menstruation usually occurs after how many weeks?

A

2-4 weeks

B

6-8 weeks

C

6 months

D

12 months

Question 16 Explanation:

When the mother does not breastfeed, the normal menstruation resumes about 6-8 weeks after delivery. This is due to the fact that after delivery, the hormones estrogen and progesterone gradually decrease thus triggering negative feedback to the anterior pituitary to release the Follicle-Stimulating Hormone (FSH) which in turn stimulates the ovary to again mature a graafian follicle and the menstrual cycle post pregnancy resumes.

Question 17

The following are nursing measures to stimulate lactation EXCEPT

A

Frequent regular breast feeding

B

Breast pumping

C

Breast massage

D

Application of cold compress on the breast

Question 17 Explanation:

To stimulate lactation, warm compress is applied on the breast. Cold application will cause vasoconstriction thus reducing the blood supply consequently the production of milk.

Question 18

When the uterus is firm and contracted after delivery but there is vaginal bleeding, the nurse should suspect

A

Laceration of soft tissues of the cervix and vagina

B

Uterine atony

C

Uterine inversion

D

Uterine hypercontractility

Question 18 Explanation:

When uterus is firm and contracted it means that the bleeding is not in the uterus but other parts of the passageway such as the cervix or the vagina.

Question 19

The following are interventions to make the fundus contract postpartally EXCEPT

A

Make the baby suck the breast regularly

B

Apply ice cap on fundus

C

Massage the fundus vigorously for 15 minutes until contracted

D

Give oxytocin as ordered

Question 19 Explanation:

Massaging the fundus of the uterus should not be vigorous and should only be done until the uterus feel firm and contracted. If massaging is vigorous and prolonged, the uterus will relax due to overstimulation.

Question 20

The following are nursing interventions to relieve episiotomy wound pain EXCEPT

A

Giving analgesic as ordered

B

Sitz bath

C

Perineal heat

D

Perineal care

Question 20 Explanation:

Perineal care is primarily done for personal hygiene regardless of whether there is pain or not; episiotomy wound or not.

Question 21

Postpartum blues is said to be normal provided that the following characteristics are present. These are

All the symptoms 1-3 are characteristic of postpartum blues. It will resolve by itself because it is transient and is due to a number of reasons like changes in hormonal levels and adjustment to motherhood. If symptoms lasts more than 2 weeks, this could be a sign of abnormality like postpartum depression and needs treatment.

Question 22

The neonatal circulation differs from the fetal circulation because

A

The fetal lungs are non-functioning as an organ and most of the blood in the fetal circulation is mixed blood.

B

The blood at the left atrium of the fetal heart is shunted to the right atrium to facilitate its passage to the lungs

C

The blood in left side of the fetal heart contains oxygenated blood while the blood in the right side contains unoxygenated blood.

D

None of the above

Question 22 Explanation:

The fetal lungs is fluid-filled while in utero and is still not functioning. It only begins to function in extra uterine life. Except for the blood as it enters the fetus immediately from the placenta, most of the fetal blood is mixed blood.

Question 23

The normal respiration of a newborn immediately after birth is characterized as:

A

Shallow and irregular with short periods of apnea lasting not longer than 15 seconds, 30-60 breaths per minute

B

20-40 breaths per minute, abdominal breathing with active use of intercostals muscles

C

30-60 breaths per minute with apnea lasting more than 15 seconds, abdominal breathing

D

30-50 breaths per minute, active use of abdominal and intercostal muscles

Question 23 Explanation:

A newly born baby still is adjusting to extra uterine life and the lungs are just beginning to function as a respiratory organ. The respiration of the baby at this time is characterized as usually shallow and irregular with short periods of apnea, 30-60 breaths per minute. The apneic periods should be brief lasting not more than 15 seconds otherwise it will be considered abnormal.

2-3 cm in both anteroposterior and transverse diameter and diamond shape

D

none of the above

Question 24 Explanation:

The anterior fontanelle is diamond shape with the antero-posterior diameter being longer than the transverse diameter. The posterior fontanelle is triangular shape.

Question 25

The ideal site for vitamin K injection in the newborn is:

A

Right upper arm

B

Left upper arm

C

Either right or left buttocks

D

Middle third of the thigh

Question 25 Explanation:

Neonates do not have well developed muscles of the arm. Since Vitamin K is given intramuscular, the site must have sufficient muscles like the middle third of the thigh.

Question 26

At what APGAR score at 5 minutes after birth should resuscitation be initiated?

A

1-3

B

7-8

C

9-10

D

6-7

Question 26 Explanation:

An APGAR of 1-3 is a sign of fetal distress which requires resuscitation. The baby is alright if the score is 8-10.

Question 27

Right after birth, when the skin of the baby’s trunk is pinkish but the soles of the feet and palm of the hands are bluish this is called:

A

Syndactyly

B

Acrocyanosis

C

Peripheral cyanosis

D

Cephalo-caudal cyanosis

Question 27 Explanation:

Acrocyanosis is the term used to describe the baby’s skin color at birth when the soles and palms are bluish but the trunk is pinkish.

Question 28

The minimum birth weight for full term babies to be considered normal is:

A

2,000 gms

B

1,500 gms

C

2,500 gms

D

3,000 gms

Question 28 Explanation:

According to the WHO standard, the minimum normal birth weight of a full term baby is 2,500 gms or 2.5 Kg.

Question 29

The procedure done to prevent ophthalmia neonatorum is:

A

Marmet’s technique

B

Crede’s method

C

Ritgen’s method

D

Ophthalmic wash

Question 29 Explanation:

Crede’s method/prophylaxis is the procedure done to prevent ophthalmia neonatorum which the baby can acquire as it passes through the birth canal of the mother. Usually, an ophthalmic ointment is used.

Question 30

Which of the following characteristics will distinguish a postmature neonate at birth?

A

Plenty of lanugo and vernix caseosa

B

Lanugo mainly on the shoulders and vernix in the skin folds

C

Pinkish skin with good turgor

D

Almost leather-like, dry, cracked skin, negligible vernix caseosa

Question 30 Explanation:

A post mature fetus has the appearance of an old person with dry wrinkled skin and the vernix caseosa has already diminished.

Question 31

What would be the appropriate first nursing action when caring for a 20-year old G1P0 woman at 39 weeks gestation who is in active labor and for whom an assessment reveals mild variable fetal heart rate decelerations?

A

Notify the physician

B

Prepare the client for immediate delivery

C

Readjust the fetal monitor

D

Change the maternal position

Question 31 Explanation:

The cause of variable fetal heart decelerations is umbilical cord compression, which can usually be corrected by changing the maternal position.

Question 32

Birth Control Methods and Infertility: In basal body temperature (BBT) technique, the sign that ovulation has occurred is an elevation of body temperature by

A

1.0-1.4 degrees centigrade

B

0.2-0.4 degrees centigrade

C

2.0-4.0 degrees centigrade

D

1.0-4.0 degrees centigrade

Question 32 Explanation:

The release of the hormone progesterone in the body following ovulation causes a slight elevation of basal body temperature of about 0.2 – 0.4 degrees centigrade

Question 33

Lactation Amenorrhea Method(LAM) can be an effective method of natural birth control if

A

The mother breast feeds mainly at night time when ovulation could possibly occur

B

The mother breastfeeds exclusively and regularly during the first 6 months without giving supplemental feedings

C

The mother uses mixed feeding faithfully

D

The mother breastfeeds regularly until 1 year with no supplemental feedings

Question 33 Explanation:

A mother who breastfeeds exclusively and regularly during the first 6 months benefits from lactation amenorrhea. There is evidence to support the observation that the benefits of lactation amenorrhea lasts for 6 months provided the woman has not had her first menstruation since delivery of the baby.

Question 34

Intrauterine device prevents pregnancy by the ff. mechanism EXCEPT

A

Endometrium inflames

B

Fundus contracts to expel uterine contents

C

Copper embedded in the IUD can kill the sperms

D

Sperms will be barred from entering the fallopian tubes

Question 34 Explanation:

An intrauterine device is a foreign body so that if it is inserted into the uterine cavity the initial reaction is to produce inflammatory process and the uterus will contract in order to try to expel the foreign body. Usually IUDs are coated with copper to serve as spermicide killing the sperms deposited into the female reproductive tract. But the IUD does not completely fill up the uterine cavity thus sperms which are microscopic is size can still pass through.

Question 35

Oral contraceptive pills are of different types. Which type is most appropriate for mothers who are breastfeeding?

A

Estrogen only

B

Progesterone only

C

Mixed type- estrogen and progesterone

D

21-day pills mixed type

Question 35 Explanation:

If mother is breastfeeding, the progesterone only type is the best because estrogen can affect lactation.

Question 36

The natural family planning method called Standard Days (SDM), is the latest type and easy to use methoD. However, it is a method applicable only to women with regular menstrual cycles between ___ to ___ days.

A

21-26 days

B

26-32 days

C

28-30 days

D

24- 36 days

Question 36 Explanation:

Standard Days Method (SDM) requires that the menstrual cycles are regular between 26-32 days. There is no need to monitor temperature or mucus secretion. This natural method of family planning is very simple since all that the woman pays attention to is her cycle. With the aid of CycleBeads, the woman can easily monitor her cycles.

Question 37

Which of the following are signs of ovulation?

A

Mittelschmerz;

B

Spinnbarkeit;

C

Thin watery cervical mucus;

D

Elevated body temperature of 4.0 degrees centigrade

Question 37 Explanation:

Mittelschmerz, spinnbarkeit and thin watery cervical mucus are signs of ovulation. When ovulation occurs, the hormone progesterone is released which can cause a slight elevation of temperature between 0.2-0.4 degrees centigrade and not 4 degrees centigrade.

Question 38

The following methods of artificial birth control works as a barrier device EXCEPT:

A

Condom

B

Cervical cap

C

Cervical Diaphragm

D

Intrauterine device (IUD)

Question 38 Explanation:

Intrauterine device prevents pregnancy by not allowing the fertilized ovum from implanting on the endometrium. Some IUDs have copper added to it which is spermicidal. It is not a barrier since the sperms can readily pass through and fertilize an ovum at the fallopian tube.

Question 39

Which of the following is a TRUE statement about normal ovulation?

A

It occurs on the 14th day of every cycle

B

It may occur between 14-16 days before next menstruation

C

Every menstrual period is always preceded by ovulation

D

The most fertile period of a woman is 2 days after ovulation

Question 39 Explanation:

Not all menstrual cycles are ovulatory. Normal ovulation in a woman occurs between the 14th to the 16th day before the NEXT menstruation. A common misconception is that ovulation occurs on the 14th day of the cycle. This is a misconception because ovulation is determined NOT from the first day of the cycle but rather 14-16 days BEFORE the next menstruation.

Question 40

If a couple would like to enhance their fertility, the following means can be done:

A

Monitor the basal body temperature of the woman everyday to determine peak period of fertility;

B

Have adequate rest and nutrition;

C

Have sexual contact only during the dry period of the woman;

D

Undergo a complete medical checkup to rule out any debilitating disease

Question 40 Explanation:

All of the above are essential for enhanced fertility except no. 3 because during the dry period the woman is in her infertile period thus even when sexual contact is done, there will be no ovulation, thus fertilization is not possible.

Question 41

In sympto-thermal method, the parameters being monitored to determine if the woman is fertile or infertile are:

A

Temperature, cervical mucus, cervical consistency

B

Release of ovum, temperature and vagina

C

Temperature and wetness

D

Temperature, endometrial secretion, mucus

Question 41 Explanation:

The 3 parameters measured/monitored which will indicate that the woman has ovulated are- temperature increase of about 0.2-0.4 degrees centigrade, softness of the cervix and cervical mucus that looks like the white of an egg which makes the woman feel “wet”.

Question 42

The following are important considerations to teach the woman who is on low dose (mini-pill) oral contraceptive EXCEPT:

A

The pill must be taken everyday at the same time

B

If the woman fails to take a pill in one day, she must take 2 pills for added protection

C

If the woman fails to take a pill in one day, she needs to take another temporary method until she has consumed the whole pack

D

If she is breastfeeding, she should discontinue using mini-pill and use the progestin-only type

Question 42 Explanation:

If the woman fails to take her usual pill for the day, taking a double dose does not give additional protection. What she needs to do is to continue taking the pills until the pack is consumed and use at the time another temporary method to ensure that no pregnancy will occur. When a new pack is started, she can already discontinue using the second temporary method she employed.

Question 43

To determine if the cause of infertility is a blockage of the fallopian tubes, the test to be done is

A

Huhner’s test

B

Rubin’s test

C

Postcoital test

D

None of the above

Question 43 Explanation:

Rubin’s test is a test to determine patency of fallopian tubes. Huhner’s test is also known as post-coital test to determine compatibility of the cervical mucus with sperms of the sexual partner.

Question 44

Infertility can be attributed to male causes such as the following EXCEPT:

A

Cryptorchidism

B

Orchitis

C

Sperm count of about 20 million per milliliter

D

Premature ejaculation

Question 44 Explanation:

Sperm count must be within normal in order for a male to successfully sire a child. The normal sperm count is 20 million per milliliter of seminal fluid or 50 million per ejaculate.

Question 45

Spinnbarkeit is an indicator of ovulation which is characterized as:

A

Thin watery mucus which can be stretched into a long strand about 10 cm

B

Thick mucus that is detached from the cervix during ovulation

C

Thin mucus that is yellowish in color with fishy odor

D

Thick mucus vaginal discharge influence by high level of estrogen

Question 45 Explanation:

At the midpoint of the cycle when the estrogen level is high, the cervical mucus becomes thin and watery to allow the sperm to easily penetrate and get to the fallopian tubes to fertilize an ovum. This is called spinnbarkeit. And the woman feels “wet”. When progesterone is secreted by the ovary, the mucus becomes thick and the woman will feel “dry”.

Question 46

Vasectomy is a procedure done on a male for sterilization. The organ involved in this procedure is

A

Prostate gland

B

Seminal vesicle

C

Testes

D

Vas deferens

Question 46 Explanation:

Vasectomy is a procedure wherein the vas deferens of the male is ligated and cut to prevent the passage of the sperms from the testes to the penis during ejaculation.

Question 47

Breast self examination is best done by the woman on herself every month during

A

The middle of her cycle to ensure that she is ovulating

B

During the menstrual period

C

Right after the menstrual period so that the breast is not being affected by the increase in hormones particularly estrogen

D

Just before the menstrual period to determine if ovulation has occurred

Question 47 Explanation:

The best time to do self breast examination is right after the menstrual period is over so that the hormonal level is low thus the breasts are not tender.

Question 48

A woman is considered to be menopause if she has experienced cessation of her menses for a period of

A

6 months

B

12 months

C

18 months

D

24 months

Question 48 Explanation:

If a woman has not had her menstrual period for 12 consecutive months, she is considered to be in her menopausal stage.

Question 49

Which of the following is the correct practice of self breast examination in a menopausal woman?

A

She should do it at the usual time that she experiences her menstrual period in the past to ensure that her hormones are not at its peak

B

Any day of the month as long it is regularly observed on the same day every month

C

Anytime she feels like doing it ideally every day

D

Menopausal women do not need regular self breast exam as long as they do it at least once every 6 months

Question 49 Explanation:

Menopausal women still need to do self examination of the breast regularly. Any day of the month is alright provided that she practices it monthly on the same day that she has chosen. The hormones estrogen and progesterone are already diminished during menopause so there is no need to consider the time to do it in relation to the menstrual cycle.

Question 50

In assisted reproductive technology (ART), there is a need to stimulate the ovaries to produce more than one mature ovA. The drug commonly used for this purpose is:

A

Bromocriptine

B

Clomiphene

C

Provera

D

Estrogen

Question 50 Explanation:

Clomiphene or Clomid acts as an ovarian stimulant to promote ovulation. The mature ova are retrieved and fertilized outside the fallopian tube (in-vitro fertilization) and after 48 hours the fertilized ovum is inserted into the uterus for implantation.

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Maternal and Child Health Nursing Practice Quiz #9 (50 Questions)

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Question 1

Postpartum Period: The fundus of the uterus is expected to go down normally postpartally about __ cm per day.

A

1.0 cm

B

2.0 cm

C

2.5 cm

D

3.0 cm

Question 1 Explanation:

The uterus will begin involution right after delivery. It is expected to regress/go down by 1 cm. per day and becomes no longer palpable about 1 week after delivery.

Question 2

The lochia on the first few days after delivery is characterized as

A

Pinkish with some blood clots

B

Whitish with some mucus

C

Reddish with some mucus

D

Serous with some brown tinged mucus

Question 2 Explanation:

Right after delivery, the vaginal discharge called lochia will be reddish because there is some blood, endometrial tissue and mucus. Since it is not pure blood it is non-clotting.

Question 3

Lochia normally disappears after how many days postpartum?

A

5 days

B

7-10 days

C

18-21 days

D

28-30 days

Question 3 Explanation:

Normally, lochia disappears after 10 days postpartum. What’s important to remember is that the color of lochia gets to be lighter (from reddish to whitish) and scantier everyday.

Question 4

After an Rh(-) mother has delivered her Rh (+) baby, the mother is given RhoGam. This is done in order to:

A

Prevent the recurrence of Rh(+) baby in future pregnancies

B

Prevent the mother from producing antibodies against the Rh(+) antigen that she may have gotten when she delivered to her Rh(+) baby

C

Ensure that future pregnancies will not lead to maternal illness

D

To prevent the newborn from having problems of incompatibility when it breastfeeds

Question 4 Explanation:

In Rh incompatibility, an Rh(-) mother will produce antibodies against the fetal Rh (+) antigen which she may have gotten because of the mixing of maternal and fetal blood during labor and delivery. Giving her RhoGam right after birth will prevent her immune system from being permanently sensitized to Rh antigen.

Question 5

To enhance milk production, a lactating mother must do the following interventions EXCEPT:

A

Increase fluid intake including milk

B

Eat foods that increases lactation which are called galactagogues

C

Exercise adequately like aerobics

D

Have adequate nutrition and rest

Question 5 Explanation:

All the above nursing measures are needed to ensure that the mother is in a healthy state. However, aerobics does not necessarily enhance lactation.

Question 6

The nursing intervention to relieve pain in breast engorgement while the mother continues to breastfeed is

A

Apply cold compress on the engorged breast

B

Apply warm compress on the engorged breast

C

Massage the breast

D

Apply analgesic ointment

Question 6 Explanation:

Warm compress is applied if the purpose is to relieve pain but ensure lactation to continue. If the purpose is to relieve pain as well as suppress lactation, the compress applied is cold.

Question 7

A woman who delivered normally per vagina is expected to void within ___ hours after delivery.

A

3 hours

B

4 hours

C

6-8 hours

D

12-24 hours

Question 7 Explanation:

A woman who has had normal delivery is expected to void within 6-8 hrs. If she is unable to do so after 8 hours, the nurse should stimulate the woman to void. If nursing interventions to stimulate spontaneous voiding don’t work, the nurse may decide to catheterize the woman.

Question 8

To ensure adequate lactation the nurse should teach the mother to:

A

Breast feed the baby on self-demand day and night

B

Feed primarily during the day and allow the baby to sleep through the night

C

Feed the baby every 3-4 hours following a strict schedule

D

Breastfeed when the breast are engorged to ensure adequate supply

Question 8 Explanation:

Feeding on self-demand means the mother feeds the baby according to baby’s need. Therefore, this means there will be regular emptying of the breasts, which is essential to maintain adequate lactation.

Question 9

An appropriate nursing intervention when caring for a postpartum mother with thrombophlebitis is:

A

Encourage the mother to ambulate to relieve the pain in the leg

B

Instruct the mother to apply elastic bondage from the foot going towards the knee to improve venous return flow

C

Apply warm compress on the affected leg to relieve the pain

D

Elevate the affected leg and keep the patient on bedrest

Question 9 Explanation:

If the mother already has thrombophlebitis, the nursing intervention is bedrest to prevent the possible dislodging of the thrombus and keeping the affected leg elevated to help reduce the inflammation.

Question 10

The nurse should anticipate that hemorrhage related to uterine atony may occur postpartally if this condition was present during the delivery:

A

Excessive analgesia was given to the mother

B

Placental delivery occurred within thirty minutes after the baby was born

C

An episiotomy had to be done to facilitate delivery of the head

D

The labor and delivery lasted for 12 hours

Question 10 Explanation:

Excessive analgesia can lead to uterine relaxation thus lead to hemorrhage postpartally. Both B and D are normal and C is at the vaginal introitus thus will not affect the uterus.

Question 11

According to Rubin’s theory of maternal role adaptation, the mother will go through 3 stages during the postpartum period. These stages are:

A

Going through, adjustment period, adaptation period

B

Taking-in, taking-hold and letting-go

C

Attachment phase, adjustment phase, adaptation phase

D

Taking-hold, letting-go, attachment phase

Question 11 Explanation:

Rubin’s theory states that the 3 stages that a mother goes through for maternal adaptation are: taking-in, taking-hold and letting-go. In the taking-in stage, the mother is more passive and dependent on others for care. In taking-hold, the mother begins to assume a more active role in the care of the child and in letting-go, the mother has become adapted to her maternal role.

Question 12

The neonate of a mother with diabetes mellitus is prone to developing hypoglycemia because:

A

The pancreas is immature and unable to secrete the needed insulin

B

There is rapid diminution of glucose level in the baby’s circulating blood and his pancreas is normally secreting insulin

C

The baby is reacting to the insulin given to the mother

D

His kidneys are immature leading to a high tolerance for glucose

Question 12 Explanation:

If the mother is diabetic, the fetus while in utero has a high supply of glucose. When the baby is born and is now separate from the mother, it no longer receives a high dose of glucose from the mother. In the first few hours after delivery, the neonate usually does not feed yet thus this can lead to hypoglycemia.

Question 13

Which of the following is an abnormal vital sign in postpartum?

A

Pulse rate between 50-60/min

B

BP diastolic increase from 80 to 95 mmHg

C

BP systolic between 100-120 mmHg

D

Respiratory rate of 16-20/min

Question 13 Explanation:

All the vital signs given in the choices are within normal range except an increase of 15mm Hg in the diastolic which is a possible sign of hypertension in pregnancy.

Question 14

The uterine fundus right after delivery of placenta is palpable at

A

Level of xiphoid process

B

Level of umbilicus

C

Level of symphysis pubis

D

Midway between umbilicus and symphysis pubis

Question 14 Explanation:

Immediately after the delivery of the placenta, the fundus of the uterus is expected to be at the level of the umbilicus because the contents of the pregnancy have already been expelled. The fundus is expected to recede by 1 fingerbreadths (1cm) everyday until it becomes no longer palpable above the symphysis pubis.

Question 15

A nurse is monitoring the amount of lochia drainage in a client who is 2 hours postpartum and notes that the client has a saturated a perineal pad in 1 hour. The nurse reports the amount of lochial flow as:

In a woman who is not breastfeeding, menstruation usually occurs after how many weeks?

A

2-4 weeks

B

6-8 weeks

C

6 months

D

12 months

Question 16 Explanation:

When the mother does not breastfeed, the normal menstruation resumes about 6-8 weeks after delivery. This is due to the fact that after delivery, the hormones estrogen and progesterone gradually decrease thus triggering negative feedback to the anterior pituitary to release the Follicle-Stimulating Hormone (FSH) which in turn stimulates the ovary to again mature a graafian follicle and the menstrual cycle post pregnancy resumes.

Question 17

The following are nursing measures to stimulate lactation EXCEPT

A

Frequent regular breast feeding

B

Breast pumping

C

Breast massage

D

Application of cold compress on the breast

Question 17 Explanation:

To stimulate lactation, warm compress is applied on the breast. Cold application will cause vasoconstriction thus reducing the blood supply consequently the production of milk.

Question 18

When the uterus is firm and contracted after delivery but there is vaginal bleeding, the nurse should suspect

A

Laceration of soft tissues of the cervix and vagina

B

Uterine atony

C

Uterine inversion

D

Uterine hypercontractility

Question 18 Explanation:

When uterus is firm and contracted it means that the bleeding is not in the uterus but other parts of the passageway such as the cervix or the vagina.

Question 19

The following are interventions to make the fundus contract postpartally EXCEPT

A

Make the baby suck the breast regularly

B

Apply ice cap on fundus

C

Massage the fundus vigorously for 15 minutes until contracted

D

Give oxytocin as ordered

Question 19 Explanation:

Massaging the fundus of the uterus should not be vigorous and should only be done until the uterus feel firm and contracted. If massaging is vigorous and prolonged, the uterus will relax due to overstimulation.

Question 20

The following are nursing interventions to relieve episiotomy wound pain EXCEPT

A

Giving analgesic as ordered

B

Sitz bath

C

Perineal heat

D

Perineal care

Question 20 Explanation:

Perineal care is primarily done for personal hygiene regardless of whether there is pain or not; episiotomy wound or not.

Question 21

Postpartum blues is said to be normal provided that the following characteristics are present. These are

All the symptoms 1-3 are characteristic of postpartum blues. It will resolve by itself because it is transient and is due to a number of reasons like changes in hormonal levels and adjustment to motherhood. If symptoms lasts more than 2 weeks, this could be a sign of abnormality like postpartum depression and needs treatment.

Question 22

The neonatal circulation differs from the fetal circulation because

A

The fetal lungs are non-functioning as an organ and most of the blood in the fetal circulation is mixed blood.

B

The blood at the left atrium of the fetal heart is shunted to the right atrium to facilitate its passage to the lungs

C

The blood in left side of the fetal heart contains oxygenated blood while the blood in the right side contains unoxygenated blood.

D

None of the above

Question 22 Explanation:

The fetal lungs is fluid-filled while in utero and is still not functioning. It only begins to function in extra uterine life. Except for the blood as it enters the fetus immediately from the placenta, most of the fetal blood is mixed blood.

Question 23

The normal respiration of a newborn immediately after birth is characterized as:

A

Shallow and irregular with short periods of apnea lasting not longer than 15 seconds, 30-60 breaths per minute

B

20-40 breaths per minute, abdominal breathing with active use of intercostals muscles

C

30-60 breaths per minute with apnea lasting more than 15 seconds, abdominal breathing

D

30-50 breaths per minute, active use of abdominal and intercostal muscles

Question 23 Explanation:

A newly born baby still is adjusting to extra uterine life and the lungs are just beginning to function as a respiratory organ. The respiration of the baby at this time is characterized as usually shallow and irregular with short periods of apnea, 30-60 breaths per minute. The apneic periods should be brief lasting not more than 15 seconds otherwise it will be considered abnormal.

2-3 cm in both anteroposterior and transverse diameter and diamond shape

D

none of the above

Question 24 Explanation:

The anterior fontanelle is diamond shape with the antero-posterior diameter being longer than the transverse diameter. The posterior fontanelle is triangular shape.

Question 25

The ideal site for vitamin K injection in the newborn is:

A

Right upper arm

B

Left upper arm

C

Either right or left buttocks

D

Middle third of the thigh

Question 25 Explanation:

Neonates do not have well developed muscles of the arm. Since Vitamin K is given intramuscular, the site must have sufficient muscles like the middle third of the thigh.

Question 26

At what APGAR score at 5 minutes after birth should resuscitation be initiated?

A

1-3

B

7-8

C

9-10

D

6-7

Question 26 Explanation:

An APGAR of 1-3 is a sign of fetal distress which requires resuscitation. The baby is alright if the score is 8-10.

Question 27

Right after birth, when the skin of the baby’s trunk is pinkish but the soles of the feet and palm of the hands are bluish this is called:

A

Syndactyly

B

Acrocyanosis

C

Peripheral cyanosis

D

Cephalo-caudal cyanosis

Question 27 Explanation:

Acrocyanosis is the term used to describe the baby’s skin color at birth when the soles and palms are bluish but the trunk is pinkish.

Question 28

The minimum birth weight for full term babies to be considered normal is:

A

2,000 gms

B

1,500 gms

C

2,500 gms

D

3,000 gms

Question 28 Explanation:

According to the WHO standard, the minimum normal birth weight of a full term baby is 2,500 gms or 2.5 Kg.

Question 29

The procedure done to prevent ophthalmia neonatorum is:

A

Marmet’s technique

B

Crede’s method

C

Ritgen’s method

D

Ophthalmic wash

Question 29 Explanation:

Crede’s method/prophylaxis is the procedure done to prevent ophthalmia neonatorum which the baby can acquire as it passes through the birth canal of the mother. Usually, an ophthalmic ointment is used.

Question 30

Which of the following characteristics will distinguish a postmature neonate at birth?

A

Plenty of lanugo and vernix caseosa

B

Lanugo mainly on the shoulders and vernix in the skin folds

C

Pinkish skin with good turgor

D

Almost leather-like, dry, cracked skin, negligible vernix caseosa

Question 30 Explanation:

A post mature fetus has the appearance of an old person with dry wrinkled skin and the vernix caseosa has already diminished.

Question 31

What would be the appropriate first nursing action when caring for a 20-year old G1P0 woman at 39 weeks gestation who is in active labor and for whom an assessment reveals mild variable fetal heart rate decelerations?

A

Notify the physician

B

Prepare the client for immediate delivery

C

Readjust the fetal monitor

D

Change the maternal position

Question 31 Explanation:

The cause of variable fetal heart decelerations is umbilical cord compression, which can usually be corrected by changing the maternal position.

Question 32

Birth Control Methods and Infertility: In basal body temperature (BBT) technique, the sign that ovulation has occurred is an elevation of body temperature by

A

1.0-1.4 degrees centigrade

B

0.2-0.4 degrees centigrade

C

2.0-4.0 degrees centigrade

D

1.0-4.0 degrees centigrade

Question 32 Explanation:

The release of the hormone progesterone in the body following ovulation causes a slight elevation of basal body temperature of about 0.2 – 0.4 degrees centigrade

Question 33

Lactation Amenorrhea Method(LAM) can be an effective method of natural birth control if

A

The mother breast feeds mainly at night time when ovulation could possibly occur

B

The mother breastfeeds exclusively and regularly during the first 6 months without giving supplemental feedings

C

The mother uses mixed feeding faithfully

D

The mother breastfeeds regularly until 1 year with no supplemental feedings

Question 33 Explanation:

A mother who breastfeeds exclusively and regularly during the first 6 months benefits from lactation amenorrhea. There is evidence to support the observation that the benefits of lactation amenorrhea lasts for 6 months provided the woman has not had her first menstruation since delivery of the baby.

Question 34

Intrauterine device prevents pregnancy by the ff. mechanism EXCEPT

A

Endometrium inflames

B

Fundus contracts to expel uterine contents

C

Copper embedded in the IUD can kill the sperms

D

Sperms will be barred from entering the fallopian tubes

Question 34 Explanation:

An intrauterine device is a foreign body so that if it is inserted into the uterine cavity the initial reaction is to produce inflammatory process and the uterus will contract in order to try to expel the foreign body. Usually IUDs are coated with copper to serve as spermicide killing the sperms deposited into the female reproductive tract. But the IUD does not completely fill up the uterine cavity thus sperms which are microscopic is size can still pass through.

Question 35

Oral contraceptive pills are of different types. Which type is most appropriate for mothers who are breastfeeding?

A

Estrogen only

B

Progesterone only

C

Mixed type- estrogen and progesterone

D

21-day pills mixed type

Question 35 Explanation:

If mother is breastfeeding, the progesterone only type is the best because estrogen can affect lactation.

Question 36

The natural family planning method called Standard Days (SDM), is the latest type and easy to use methoD. However, it is a method applicable only to women with regular menstrual cycles between ___ to ___ days.

A

21-26 days

B

26-32 days

C

28-30 days

D

24- 36 days

Question 36 Explanation:

Standard Days Method (SDM) requires that the menstrual cycles are regular between 26-32 days. There is no need to monitor temperature or mucus secretion. This natural method of family planning is very simple since all that the woman pays attention to is her cycle. With the aid of CycleBeads, the woman can easily monitor her cycles.

Question 37

Which of the following are signs of ovulation?

A

Mittelschmerz;

B

Spinnbarkeit;

C

Thin watery cervical mucus;

D

Elevated body temperature of 4.0 degrees centigrade

Question 37 Explanation:

Mittelschmerz, spinnbarkeit and thin watery cervical mucus are signs of ovulation. When ovulation occurs, the hormone progesterone is released which can cause a slight elevation of temperature between 0.2-0.4 degrees centigrade and not 4 degrees centigrade.

Question 38

The following methods of artificial birth control works as a barrier device EXCEPT:

A

Condom

B

Cervical cap

C

Cervical Diaphragm

D

Intrauterine device (IUD)

Question 38 Explanation:

Intrauterine device prevents pregnancy by not allowing the fertilized ovum from implanting on the endometrium. Some IUDs have copper added to it which is spermicidal. It is not a barrier since the sperms can readily pass through and fertilize an ovum at the fallopian tube.

Question 39

Which of the following is a TRUE statement about normal ovulation?

A

It occurs on the 14th day of every cycle

B

It may occur between 14-16 days before next menstruation

C

Every menstrual period is always preceded by ovulation

D

The most fertile period of a woman is 2 days after ovulation

Question 39 Explanation:

Not all menstrual cycles are ovulatory. Normal ovulation in a woman occurs between the 14th to the 16th day before the NEXT menstruation. A common misconception is that ovulation occurs on the 14th day of the cycle. This is a misconception because ovulation is determined NOT from the first day of the cycle but rather 14-16 days BEFORE the next menstruation.

Question 40

If a couple would like to enhance their fertility, the following means can be done:

A

Monitor the basal body temperature of the woman everyday to determine peak period of fertility;

B

Have adequate rest and nutrition;

C

Have sexual contact only during the dry period of the woman;

D

Undergo a complete medical checkup to rule out any debilitating disease

Question 40 Explanation:

All of the above are essential for enhanced fertility except no. 3 because during the dry period the woman is in her infertile period thus even when sexual contact is done, there will be no ovulation, thus fertilization is not possible.

Question 41

In sympto-thermal method, the parameters being monitored to determine if the woman is fertile or infertile are:

A

Temperature, cervical mucus, cervical consistency

B

Release of ovum, temperature and vagina

C

Temperature and wetness

D

Temperature, endometrial secretion, mucus

Question 41 Explanation:

The 3 parameters measured/monitored which will indicate that the woman has ovulated are- temperature increase of about 0.2-0.4 degrees centigrade, softness of the cervix and cervical mucus that looks like the white of an egg which makes the woman feel “wet”.

Question 42

The following are important considerations to teach the woman who is on low dose (mini-pill) oral contraceptive EXCEPT:

A

The pill must be taken everyday at the same time

B

If the woman fails to take a pill in one day, she must take 2 pills for added protection

C

If the woman fails to take a pill in one day, she needs to take another temporary method until she has consumed the whole pack

D

If she is breastfeeding, she should discontinue using mini-pill and use the progestin-only type

Question 42 Explanation:

If the woman fails to take her usual pill for the day, taking a double dose does not give additional protection. What she needs to do is to continue taking the pills until the pack is consumed and use at the time another temporary method to ensure that no pregnancy will occur. When a new pack is started, she can already discontinue using the second temporary method she employed.

Question 43

To determine if the cause of infertility is a blockage of the fallopian tubes, the test to be done is

A

Huhner’s test

B

Rubin’s test

C

Postcoital test

D

None of the above

Question 43 Explanation:

Rubin’s test is a test to determine patency of fallopian tubes. Huhner’s test is also known as post-coital test to determine compatibility of the cervical mucus with sperms of the sexual partner.

Question 44

Infertility can be attributed to male causes such as the following EXCEPT:

A

Cryptorchidism

B

Orchitis

C

Sperm count of about 20 million per milliliter

D

Premature ejaculation

Question 44 Explanation:

Sperm count must be within normal in order for a male to successfully sire a child. The normal sperm count is 20 million per milliliter of seminal fluid or 50 million per ejaculate.

Question 45

Spinnbarkeit is an indicator of ovulation which is characterized as:

A

Thin watery mucus which can be stretched into a long strand about 10 cm

B

Thick mucus that is detached from the cervix during ovulation

C

Thin mucus that is yellowish in color with fishy odor

D

Thick mucus vaginal discharge influence by high level of estrogen

Question 45 Explanation:

At the midpoint of the cycle when the estrogen level is high, the cervical mucus becomes thin and watery to allow the sperm to easily penetrate and get to the fallopian tubes to fertilize an ovum. This is called spinnbarkeit. And the woman feels “wet”. When progesterone is secreted by the ovary, the mucus becomes thick and the woman will feel “dry”.

Question 46

Vasectomy is a procedure done on a male for sterilization. The organ involved in this procedure is

A

Prostate gland

B

Seminal vesicle

C

Testes

D

Vas deferens

Question 46 Explanation:

Vasectomy is a procedure wherein the vas deferens of the male is ligated and cut to prevent the passage of the sperms from the testes to the penis during ejaculation.

Question 47

Breast self examination is best done by the woman on herself every month during

A

The middle of her cycle to ensure that she is ovulating

B

During the menstrual period

C

Right after the menstrual period so that the breast is not being affected by the increase in hormones particularly estrogen

D

Just before the menstrual period to determine if ovulation has occurred

Question 47 Explanation:

The best time to do self breast examination is right after the menstrual period is over so that the hormonal level is low thus the breasts are not tender.

Question 48

A woman is considered to be menopause if she has experienced cessation of her menses for a period of

A

6 months

B

12 months

C

18 months

D

24 months

Question 48 Explanation:

If a woman has not had her menstrual period for 12 consecutive months, she is considered to be in her menopausal stage.

Question 49

Which of the following is the correct practice of self breast examination in a menopausal woman?

A

She should do it at the usual time that she experiences her menstrual period in the past to ensure that her hormones are not at its peak

B

Any day of the month as long it is regularly observed on the same day every month

C

Anytime she feels like doing it ideally every day

D

Menopausal women do not need regular self breast exam as long as they do it at least once every 6 months

Question 49 Explanation:

Menopausal women still need to do self examination of the breast regularly. Any day of the month is alright provided that she practices it monthly on the same day that she has chosen. The hormones estrogen and progesterone are already diminished during menopause so there is no need to consider the time to do it in relation to the menstrual cycle.

Question 50

In assisted reproductive technology (ART), there is a need to stimulate the ovaries to produce more than one mature ovA. The drug commonly used for this purpose is:

A

Bromocriptine

B

Clomiphene

C

Provera

D

Estrogen

Question 50 Explanation:

Clomiphene or Clomid acts as an ovarian stimulant to promote ovulation. The mature ova are retrieved and fertilized outside the fallopian tube (in-vitro fertilization) and after 48 hours the fertilized ovum is inserted into the uterus for implantation.

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1. Postpartum Period:The fundus of the uterus is expected to go down normally postpartally about __ cm per day.

A. 1.0 cm
B. 2.0 cm
C. 2.5 cm
D. 3.0 cm

2. The lochia on the first few days after delivery is characterized as

A. Pinkish with some blood clots
B. Whitish with some mucus
C. Reddish with some mucus
D. Serous with some brown tinged mucus

4. After a Rh(-) mother has delivered her Rh (+) baby, the mother is given RhoGam. This is done in order to:

A. Prevent the recurrence of Rh(+) baby in future pregnancies
B. Prevent the mother from producing antibodies against the Rh(+) antigen that she may have gotten when she delivered to her Rh(+) baby
C. Ensure those future pregnancies will not lead to maternal illness
D. To prevent the newborn from having problems of incompatibility when it breastfeeds

5. To enhance milk production, a lactating mother must do the following interventions EXCEPT:

7. A woman who delivered normally per vagina is expected to void within ___ hours after delivery.

A. 3 hrs
B. 4 hrs.
C. 6-8 hrs
D. 12-24 hours

8. To ensure adequate lactation the nurse should teach the mother to:

A. Breastfeed the baby on self-demand day and night
B. Feed primarily during the day and allow the baby to sleep through the night
C. Feed the baby every 3-4 hours following a strict schedule
D. Breastfeed when the breast are engorged to ensure adequate supply

A. Encourage the mother to ambulate to relieve the pain in the leg
B. Instruct the mother to apply elastic bondage from the foot going towards the knee to improve venous return flow
C. Apply warm compress on the affected leg to relieve the pain
D. Elevate the affected leg and keep the patient on bedrest

10. The nurse should anticipate that hemorrhage related to uterine atony may occur postnatally if this condition was present during the delivery:

A. Excessive analgesia was given to the mother
B. Placental delivery occurred within thirty minutes after the baby was born
C. An episiotomy had to be done to facilitate delivery of the head
D. The labor and delivery lasted for 12 hours

11. According to Rubin’s theory of maternal role adaptation, the mother will go through 3 stages during the postpartum perioD. These stages are:

A. The pancreas is immature and unable to secrete the needed insulin
B. There is rapid diminution of glucose level in the baby’s circulating blood and his pancreas is normally secreting insulin
C. The baby is reacting to the insulin given to the mother
D. His kidneys are immature leading to a high tolerance for glucose

15. A nurse is monitoring the amount of lochia drainage in a client who is 2 hours postpartum and notes that the client has a saturated a perineal pad in 1 hour. The nurse reports the amount of lochial flow as:

A. Excessive
B. Heavy
C. Light
D. Scanty

16. In a woman who is not breastfeeding, menstruation usually occurs after how many weeks?

22. The neonatal circulation differs from the fetal circulation because

A. The fetal lungs are non-functioning as an organ and most of the blood in the fetal circulation is mixed blooD.
B. The blood at the left atrium of the fetal heart is shunted to the right atrium to facilitate its passage to the lungs
C. The blood in the left side of the fetal heart contains oxygenated blood while the blood on the right side contains unoxygenated blooD.
D. None of the above

23. The normal respiration of a newborn immediately after birth is characterized as:

A. Shallow and irregular with short periods of apnea lasting not longer than 15 seconds, 30-60 breaths per minute
B. 20-40 breaths per minute, abdominal breathing with active use of intercostals muscles
C. 30-60 breaths per minute with apnea lasting more than 15 seconds, abdominal breathing
D. 30-50 breaths per minute, active use of abdominal and intercostal muscles

31. What would be the appropriate first nursing action when caring for a 20-year old G1P0 woman at 39 weeks gestation who is in active labor and for whom an assessment reveals mild variable fetal heart rate decelerations?

33. Lactation Amenorrhea Method(LAM) can be an effective method of natural birth control if

A. The mother breastfeeds mainly at night time when ovulation could possibly occur
B. The mother breastfeeds exclusively and regularly during the first 6 months without giving supplemental feedings
C. The mother uses mixed feeding faithfully
D. The mother breastfeeds regularly until 1 year with no supplemental feedings

36. The natural family planning method called Standard Days (SDM), is the latest type and easy to use methoD. However, it is a method applicable only to women with regular menstrual cycles between ___ to ___ days.

39. Which of the following is a TRUE statement about normal ovulation?

A. It occurs on the 14th day of every cycle
B. It may occur between 14-16 days before next menstruation
C. Every menstrual period is always preceded by ovulation
D. The most fertile period of a woman is 2 days after ovulation

40. If a couple would like to enhance their fertility, the following means can be done:

1. Monitor the basal body temperature of the woman every day to determine peak period of fertility;2. Have adequate rest and nutrition;3. Have sexual contact only during the dry period of the woman;4. Undergo a complete medical check-up to rule out any debilitating disease

A. 1 only
B. 1 & 4
C. 1,2,4
D. 1,2,3,4

41. In the sympto-thermal method, the parameters being monitored to determine if the woman is fertile or infertile are:

42. The following are important considerations to teach the woman who is on a low dose (mini-pill) oral contraceptive EXCEPT:

A. The pill must be taken every day at the same time
B. If the woman fails to take a pill in one day, she must take 2 pills for added protection
C. If the woman fails to take a pill in one day, she needs to take another temporary method until she has consumed the whole pack
D. If she is breastfeeding, she should discontinue using mini-pill and use the progestin-only type

43. To determine if the cause of infertility is a blockage of the fallopian tubes, the test to be done is

45. Spinnbarkeit is an indicator of ovulation which is characterized as:

A. Thin watery mucus which can be stretched into a long strand about 10 cm
B. Thick mucus that is detached from the cervix during ovulation
C. Thin mucus that is yellowish in color with fishy odor
D. Thick mucus vaginal discharge influence by high level of estrogen

46. Vasectomy is a procedure done on a male for sterilization. The organ involved in this procedure is

A. Prostate gland
B. Seminal vesicle
C. Testes
D. Vas deferens

47. Breast self-examination is best done by the woman on herself every month during

A. The middle of her cycle to ensure that she is ovulating
B. During the menstrual period
C. Right after the menstrual period so that the breast is not being affected by the increase in hormones particularly estrogen
D. Just before the menstrual period to determine if ovulation has occurred

48. A woman is considered to be menopause if she has experienced cessation of her menses for a period of

A. 6 months
B. 12 months
C. 18 months
D. 24 months

49. Which of the following is the correct practice of self-breast examination in a menopausal woman?

A. She should do it at the usual time that she experiences her menstrual period in the past to ensure that her hormones are not at its peak
B. Any day of the month as long it is regularly observed on the same day every month
C. Anytime she feels like doing it ideally every day
D. Menopausal women do not need regular self-breast exam as long as they do it at least once every 6 months

50. In assisted reproductive technology (ART), there is a need to stimulate the ovaries to produce more than one mature ovA. The drug commonly used for this purpose is:

Answers and Rationale

1. Answer: A. 1.0 cm
The uterus will begin involution right after delivery. It is expected to regress/go down by 1 cm. per day and becomes no longer palpable about 1 week after delivery.

2. Answer: C. Reddish with some mucus
Right after delivery, the vaginal discharge called lochia will be reddish because there is some blood, endometrial tissue, and mucus. Since it is not pure blood it is non-clotting.

3. Answer: B. 7-10 days
Normally, lochia disappears after 10 days postpartum. What’s important to remember is that the color of lochia gets to be lighter (from reddish to whitish) and scantier every day.

4. Answer: B. Prevent the mother from producing antibodies against the Rh(+) antigen that she may have gotten when she delivered to her Rh(+) baby
In Rh incompatibility, a Rh(-) mother will produce antibodies against the fetal Rh (+) antigen which she may have gotten because of the mixing of maternal and fetal blood during labor and delivery. Giving her RhoGam right after birth will prevent her immune system from being permanently sensitized to Rh antigen.

5. Answer: C. Exercise adequately like aerobics
All the above nursing measures are needed to ensure that the mother is in a healthy state. However, aerobics does not necessarily enhance lactation.

6. Answer: B. Apply warm compress on the engorged breast
Warm compress is applied if the purpose is to relieve pain but ensure lactation to continue. If the purpose is to relieve pain as well as suppress lactation, the compress applied is cold.

7. Answer: C. 6-8 hrs
A woman who has had normal delivery is expected to void within 6-8 hrs. If she is unable to do so after 8 hours, the nurse should stimulate the woman to void. If nursing interventions to stimulate spontaneous voiding don’t work, the nurse may decide to catheterize the woman.

8. Answer: A. Breastfeed the baby on self-demand day and night
Feeding on self-demand means the mother feeds the baby according to baby’s need. Therefore, this means there will be regular emptying of the breasts, which is essential to maintain adequate lactation.

9. Answer: D. Elevate the affected leg and keep the patient on bedrest
If the mother already has thrombophlebitis, the nursing intervention is bedrest to prevent the possible dislodging of the thrombus and keeping the affected leg elevated to help reduce the inflammation.

10. Answer: A. Excessive analgesia was given to the mother
Excessive analgesia can lead to uterine relaxation thus lead to hemorrhage postpartally. Both B and D are normal and C is at the vaginal introitus thus will not affect the uterus.

11. Answer: B. Taking-in, taking-hold and letting-go
Rubin’s theory states that the 3 stages that a mother goes through for maternal adaptation are: taking-in, taking-hold and letting-go. In the taking-in stage, the mother is more passive and dependent on others for care. In taking-hold, the mother begins to assume a more active role in the care of the child and in letting-go, the mother has become adapted to her maternal role.

12. Answer: B. There is rapid diminution of glucose level in the baby’s circulating blood and his pancreas is normally secreting insulin
If the mother is diabetic, the fetus while in utero has a high supply of glucose. When the baby is born and is now separate from the mother, it no longer receives a high dose of glucose from the mother. In the first few hours after delivery, the neonate usually does not feed yet thus this can lead to hypoglycemia.

13. Answer: B. BP diastolic increase from 80 to 95mm Hg
All the vital signs given in the choices are within normal range except an increase of 15mm Hg in the diastolic which is a possible sign of hypertension in pregnancy.

14. Answer: B. Level of umbilicus
Immediately after the delivery of the placenta, the fundus of the uterus is expected to be at the level of the umbilicus because the contents of the pregnancy have already been expelled. The fundus is expected to recede by 1 fingerbreadths (1cm) every day until it becomes no longer palpable above the symphysis pubis.

16. Answer: B. 6-8 weeks
When the mother does not breastfeed, the normal menstruation resumes about 6-8 weeks after delivery. This is due to the fact that after delivery, the hormones estrogen and progesterone gradually decrease thus triggering negative feedback to the anterior pituitary to release the Follicle-Stimulating Hormone (FSH) which in turn stimulates the ovary to again mature a Graafian follicle and the menstrual cycle post pregnancy resumes.

17. Answer: D. Application of cold compress on the breast
To stimulate lactation, a warm compress is applied to the breast. A cold application will cause vasoconstriction thus reducing the blood supply consequently the production of milk.

18. Answer: A. Laceration of soft tissues of the cervix and vagina
When the uterus is firm and contracted it means that the bleeding is not in the uterus but other parts of the passageway such as the cervix or the vagina.

19. Answer: C. Massage the fundus vigorously for 15 minutes until contracted
Massaging the fundus of the uterus should not be vigorous and should only be done until the uterus feels firm and contracted. If the massage is vigorous and prolonged, the uterus will relax due to over stimulation.

21. Answer: A. All of the above
All the symptoms 1-3 are characteristic of postpartal blues. It will resolve by itself because it is transient and is due to a number of reasons like changes in hormonal levels and adjustment to motherhood. If symptoms last more than 2 weeks, this could be a sign of abnormality like postpartum depression and needs treatment.

22. Answer: A. The fetal lungs are non-functioning as an organ and most of the blood in the fetal circulation is mixed blood.
The fetal lungs are fluid-filled while in utero and are still not functioning. It only begins to function in extrauterine life. Except for the blood as it enters the fetus immediately from the placenta, most of the fetal blood is mixed blood.

23. Answer: A. Shallow and irregular with short periods of apnea lasting not longer than 15 seconds, 30-60 breaths per minute
A newly born baby still is adjusting to extra uterine life and the lungs are just beginning to function as a respiratory organ. The respiration of the baby at this time is characterized as usually shallow and irregular with short periods of apnea, 30-60 breaths per minute. The apneic periods should be brief lasting, not more than 15 seconds otherwise it will be considered abnormal.

24. Answer: A. 3-4 cm anteroposterior diameter and 2-3 cm transverse diameter, diamond shape
The anterior fontanelle is a diamond shape with the anteroposterior diameter being longer than the transverse diameter. The posterior fontanelle is a triangular shape.

25.Answer: D. Middle third of the thigh
Neonates do not have well-developed muscles of the arm. Since Vitamin K is given intramuscular, the site must have sufficient muscles like the middle third of the thigh.

26.Answer: A. 1-3
An APGAR of 1-3 is a sign of fetal distress which requires resuscitation. The baby is alright if the score is 8-10.

27. Answer: B. Acrocyanosis
Acrocyanosis is the term used to describe the baby’s skin color at birth when the soles and palms are bluish but the trunk is pinkish.

28. Answer: C. 2,500gms
According to the WHO standard, the minimum normal birth weight of a full-term baby is 2,500 gms or 2.5 Kg.

29. Answer: B. Crede’s method
Crede’s method/prophylaxis is the procedure done to prevent ophthalmia neonatorum which the baby can acquire as it passes through the birth canal of the mother. Usually, an ophthalmic ointment is used.

30. Answer: D. Almost leather-like, dry, cracked skin, negligible vernix caseosa
A post mature fetus has the appearance of an old person with dry wrinkled skin and the vernix caseosa has already diminished.

31. Answer: D. Change the maternal position
The cause of variable fetal heart decelerations is umbilical cord compression, which can usually be corrected by changing the maternal position.

32. Answer: B. 0.2-0.4 degrees centigrade
The release of the hormone progesterone in the body following ovulation causes a slight elevation of basal body temperature of about 0.2 – 0.4 degrees centigrade

33. Answer: B. The mother breastfeeds exclusively and regularly during the first 6 months without giving supplemental feedings
A mother who breastfeeds exclusively and regularly during the first 6 months benefits from lactation amenorrhea. There is evidence to support the observation that the benefits of lactation amenorrhea last for 6 months provided the woman has not had her first menstruation since delivery of the baby.

34. Answer: D. Sperms will be barred from entering the fallopian tubes
An intrauterine device is a foreign body so that if it is inserted into the uterine cavity, the initial reaction is to produce inflammatory process and the uterus will contract in order to try to expel the foreign body. Usually, IUDs are coated with copper to serve as spermicide killing the sperms deposited into the female reproductive tract. But the IUD does not completely fill up the uterine cavity thus sperms which are microscopic is size can still pass through.

36. Answer: B. 26-32 days
Standard Days Method (SDM) requires that the menstrual cycles are regular between 26-32 days. There is no need to monitor temperature or mucus secretion. This natural method of family planning is very simple since all that the woman pays attention to is her cycle. With the aid of CycleBeads, the woman can easily monitor her cycles.

37. Answer: B. 1, 2, & 3
Mittelschmerz, spinnbarkeit and thin watery cervical mucus are signs of ovulation. When ovulation occurs, the hormone progesterone is released which can cause a slight elevation of temperature between 0.2-0.4 degrees centigrade and not 4 degrees centigrade.

38. Answer: D. Intrauterine device (IUD)
Intrauterine device prevents pregnancy by not allowing the fertilized ovum from implanting on the endometrium. Some IUDs have copper added to it which is spermicidal. It is not a barrier since the sperms can readily pass through and fertilize an ovum at the fallopian tube.

39. Answer: B. It may occur between 14-16 days before next menstruation
Not all menstrual cycles are ovulatory. Normal ovulation in a woman occurs between the 14th to the 16th day before the NEXT menstruation. A common misconception is that ovulation occurs on the 14th day of the cycle. This is a misconception because ovulation is determined NOT from the first day of the cycle but rather 14-16 days BEFORE the next menstruation.

40. Answer: C. 1,2,4
All of the above are essential for enhanced fertility except no. 3 because during the dry period the woman is in her infertile period thus even when sexual contact is done, there will be no ovulation, thus fertilization is not possible.

41.Answer: A. Temperature, cervical mucus, cervical consistency
The 3 parameters measured/monitored which will indicate that the woman has ovulated are- a temperature increase of about 0.2-0.4 degrees centigrade, a softness of the cervix and cervical mucus that looks like the white of an egg which makes the woman feel “wet”.

42. Answer: B. If the woman fails to take a pill in one day, she must take 2 pills for added protection
If the woman fails to take her usual pill for the day, taking a double dose does not give additional protection. What she needs to do is to continue taking the pills until the pack is consumed and use at the time another temporary method to ensure that no pregnancy will occur. When a new pack is started, she can already discontinue using the second temporary method she employed.

43.Answer: B. Rubin’s test
Rubin’s test is a test to determine patency of fallopian tubes. Huhner’s test is also known as post-coital test to determine the compatibility of the cervical mucus with sperms of the sexual partner.

44. Answer: C. Sperm count of about 20 million per milliliter
Sperm count must be within normal in order for a male to successfully sire a child. The normal sperm count is 20 million per milliliter of seminal fluid or 50 million per ejaculate.

45. Answer: A. Thin watery mucus which can be stretched into a long strand about 10 cm
At the midpoint of the cycle when the estrogen level is high, the cervical mucus becomes thin and watery to allow the sperm to easily penetrate and get to the fallopian tubes to fertilize an ovum. This is called spinnbarkeit. And the woman feels “wet”. When progesterone is secreted by the ovary, the mucus becomes thick and the woman will feel “dry”.

46. Answer: D. Vas deferens
Vasectomy is a procedure wherein the vas deferens of the male is ligated and cut to prevent the passage of the sperms from the testes to the penis during ejaculation.

47. Answer: C. Right after the menstrual period so that the breast is not being affected by the increase in hormones particularly estrogen

The best time to do self-breast examination is right after the menstrual period is over so that the hormonal level is low thus the breasts are not tender.

48. Answer: B. 12 months

If a woman has not had her menstrual period for 12 consecutive months, she is considered to be in her menopausal stage.

49. Answer: B. Any day of the month as long it is regularly observed on the same day every month
Menopausal women still need to do self-examination of the breast regularly. Any day of the month is alright provided that she practices it monthly on the same day that she has chosen. The hormones estrogen and progesterone are already diminished during menopause so there is no need to consider the time to do it in relation to the menstrual cycle.

50. Answer: B. Clomiphene

Clomiphene or Clomid acts as an ovarian stimulant to promote ovulation. The mature ova are retrieved and fertilized outside the fallopian tube (in-vitro fertilization) and after 48 hours the fertilized ovum is inserted into the uterus for implantation.